How to Manage IBS and Chronic Constipation

Periodic constipation strikes almost everyone from time to time. Nuisance that it is, the occasional bout usually resolves with moderate lifestyle changes and is no major threat to a person’s well-being.

When a change in bowel habits strikes, it’s a good time to let your doctor know about your symptoms. Constipation can seriously compromise the quality of life for people with irritable bowel syndrome with constipation (IBS-C) or chronic idiopathic constipation—idiopathic meaning the cause is uncertain or unknown.

To help patients and their doctors find the best ways to deal with IBS-C and chronic idiopathic constipation, two major gastroenterology societies, the American Gastroenterology Association (AGA) and the American College of Gastroenterology (ACG), compiled guidelines based on their reviews of studies in the medical literature. Although the evidence they found was not always strong enough to recommend a particular therapy, the guidelines can help patients and their doctors examine their options and decide on a treatment.

The fiber difference

Not surprisingly, patients with gastrointestinal distress often blame their diets for their discomfort, and many are inclined to make significant changes in what they eat. But while some studies suggest that going gluten-free or restricting certain types of carbohydrates may be helpful, more research is needed before doctors can recommend these diets, which can be stringent and hard to follow.

Dietary fiber has been more thoroughly studied. All the same, the status of fiber as a treatment for IBS-C or chronic idiopathic constipation remains murky, because although some patients are helped by fiber, others don’t get relief. While patients with any type of constipation are often directed to increase their fiber intake, some types of fiber may be more beneficial than others.

In the case of IBS-C and chronic idiopathic constipation, psyllium and soluble fiber, which is found in oat bran, peas, certain seeds and nuts, and some fruits and vegetables, may be more helpful. On the other hand, insoluble fiber, such as that found in whole wheat and wheat bran, can make symptoms worse. Simply put, the right type may help and probably won’t hurt, but overdoing fiber intake can cause bloating and discomfort in anyone.

If you’re thinking about taking supplemental fiber, it’s best to add it gradually to reduce the bloating and discomfort.

Introducing bacteria

IBS sufferers have long turned to prebiotics and probiotics hoping that such preparations might reestablish a healthy gut environment and clear up their symptoms. Researchers have been a bit slow to look into this approach, and current studies are hampered by rampant heterogeneity—that is, the trials are conducted using different strains of bacteria, a wide assortment of preparations, and many different patient populations, which makes it impossible to categorically support or refute an intervention’s effectiveness.

Nonetheless, probiotics may help improve bloating and flatulence in IBS patients. There isn’t quite enough evidence to recommend probiotics for people with chronic idiopathic constipation, but they may improve symptoms somewhat.

Prescription drugs and laxatives

There are also a number of pharmaceutical interventions that can help people with IBS-C and chronic idiopathic constipation. But while the guidelines recommend the use of some medications over not using medications at all, these recommendations vary in their strength.

For instance, both gastroenterology societies strongly recommend linaclotide (Linzess), which helps relieve abdominal pain as well as constipation. But the recommendation for a similar type of medication, lubiprostone (Amitiza), which may improve overall symptoms slightly, is not as strong. Both drugs can be expensive, and can cause loose stools and other side effects, so doctors tend to reserve these drugs for tougher cases that have not responded to basic remedies.

Polyethylene glycol (PEG) laxatives, such as Miralax, which draw water into the bowel, are less expensive. PEG products do relieve constipation and may be quite helpful for people with chronic idiopathic constipation, but they may not relieve other symptoms like bloating or help people with IBS-C feel better overall. These first-line drugs are good for people who are having constipation-predominant symptoms, but they may need to be used in combination with other therapies in people with IBS-C.

Certain stimulant laxatives, namely sodium picosulfate and bisacodyl (Ducolax, Correctol), may also be helpful for patients with CIC, but other types commonly used by constipation sufferers, such as senna and castor oil, are not routinely recommended.

Another pharmaceutical therapy that has been gaining popularity in recent years is the use of antidepressants to help patients cope with the stress of their condition. Both selective seratonin reuptake inhibitors (SSRIs) and tricyclic antidepressants may help improve mood and even relieve abdominal pain, but their potential side effects need to be taken into account—people have different levels of tolerance for different antidepressants, and tricyclics in particular can cause constipation.

It may not be easy to talk to your doctor about constipation, but having a good relationship with your provider is a great tool to help deal with IBS-C and chronic idiopathic constipation.

To make the best use of your time in the office, spend a week before your visit keeping a record of symptoms to help you identify triggers or situations that make you feel worse. Then you and your doctor can determine a course of action, which may incorporate lifestyle modification and therapeutic intervention. Ultimately, IBS-C and chronic idiopathic constipation can be managed effectively.